selegiline

Adjunctive therapy

Brands: Eldepryl, Zelapar

Last reviewed 2025-10-05

Reviewed by PsychMed Editorial Team.

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Quick answers

What is selegiline?
Selegiline (Eldepryl tablets, Zelapar orally disintegrating tablets) is a selective monoamine oxidase B (MAO-B) inhibitor used primarily as adjunct therapy for Parkinson disease; at antidepressant doses (≥30 mg/day) it becomes a nonselective MAOI and requires tyramine-restricted diet and drug-washout precautions.
What is Eldepryl?
Eldepryl is a brand name for selegiline (other brands: Zelapar).
What is Eldepryl (selegiline) used for?
Label indications include: Adjunct for major depressive disorder (under EMSAM brand) and Parkinson disease (oral formulations).
What drug class is Eldepryl (selegiline)?
Selective MAO-B inhibitor at low doses; becomes nonselective at 10 mg/day, increasing serotonin and norepinephrine.
What strengths does Eldepryl (selegiline) come in?
Tablets: 5 mg scored.

Snapshot

Class: Adjunctive therapy
Common US brands: Eldepryl, Zelapar
Therapeutic drug monitoring not routinely recommended.
Last reviewed: 2025-10-05

Label indications

Adjunct for major depressive disorder (under EMSAM brand) and Parkinson disease (oral formulations).

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Clinical Highlights

Selegiline (Eldepryl tablets, Zelapar orally disintegrating tablets) is a selective monoamine oxidase B (MAO-B) inhibitor used primarily as adjunct therapy for Parkinson disease; at antidepressant doses (≥30 mg/day) it becomes a nonselective MAOI and requires tyramine-restricted diet and drug-washout precautions. Amphetamine metabolites contribute to wakefulness, so doses are scheduled in the morning and early afternoon to limit insomnia; patient counseling focuses on blood pressure monitoring and interaction avoidance.

Modern depression guidelines generally prefer the selegiline transdermal system for psychiatric use, reserving oral formulations for legacy regimens or when patients already receive selegiline for Parkinson disease and need additional mood benefit.
Because of interaction burden and dietary restrictions at antidepressant doses, many psychiatric patients convert to the transdermal formulation; oral selegiline largely remains in Parkinson clinics or legacy depression regimens where patients are already educated on MAOI precautions.
The compare view can help decide between oral versus patch MAOI strategies, and the Selegiline evidence feed can support escalation planning toward antidepressant-dose therapy.
Adjunct to levodopa/carbidopa in Parkinson disease (FDA 1989)
Generic: Both tablets and ODTs are available as generics, though ODT supply can be intermittent.

Dosing & Formulations

Tablets: 5 mg scored. Orally disintegrating tablets: 1.25 mg, 2.5 mg.

Parkinson disease: 5 mg tablet with breakfast and lunch (max 10 mg/day); Zelapar ODT 1.25 mg each morning, titratable to 2.5 mg/day.
Legacy antidepressant (off-label): begin 5 mg three times daily, titrate cautiously to 10 mg three times daily while enforcing tyramine restriction and monitoring blood pressure.
Schedule doses early in the day to avoid insomnia; restart titration if treatment is interrupted for >1 week.

Monitoring & Risks

Boxed warning: Risk of hypertensive crisis with tyramine-containing foods or sympathomimetics when MAO-A is inhibited; provide dietary education and emergency instructions. Insomnia/activation: Stimulant-like metabolites can disrupt sleep; dose in the morning and early afternoon.

Orthostatic hypotension: Monitor seated/standing blood pressure, especially when combined with levodopa.
Nausea: Often transient; taking with food (tablets) or adjusting timing can help.
Serotonin syndrome with serotonergic agents—observe mandatory washouts before/after therapy.
Hallucinations or confusion in Parkinson populations, particularly when combined with dopaminergic therapy.

Drug Interactions

Absolute contraindications: serotonergic antidepressants, other MAOIs, linezolid, cyclobenzaprine, meperidine, tramadol, methadone, sympathomimetic appetite suppressants, and dextromethorphan. Allow ≥14-day washouts (5 weeks for fluoxetine) when transitioning to or from interacting medications.

Avoid vasoconstrictor-containing local anesthetics and OTC sympathomimetics (pseudoephedrine, phenylephrine).

Practice Notes

Provide written lists of prohibited foods/medications and emphasize blood pressure monitoring during dose adjustments. Consider switching to the transdermal system when antidepressant efficacy is needed without extensive dietary restrictions.

Screen for bipolar spectrum symptoms—oral selegiline can precipitate mania/hypomania; partner with the bipolar disorder hub when mood elevation appears.

References

Selegiline oral tablets prescribing information — DailyMed (2024)
Clinical management of oral MAOIs — Journal of Clinical Psychopharmacology (2022)
Monoamine oxidase inhibitors: Seriously underused in the treatment of major depression — Acta Psychiatrica Scandinavica (2024)
APA Clinical Practice Guideline for the Treatment of Depression — American Psychiatric Association (2023)Guidelinedepressionclinical
CANMAT recommendations for monoamine oxidase inhibitors — Canadian Journal of Psychiatry (2024)